A pioneering Danish study found that tee-totallers got pregnant much sooner than even very light 'social' drinkers and they had a lower miscarriage rate. Anna Magee

‘Alcohol affects just about every system because it’s a small molecule that goes everywhere in the body,’ says Paul Wallace, emeritus professor of public health at University College London and medical director of the charity Drinkaware. ‘From the gut to the heart, the blood vessels to the skin, its effects are all pervasive.’ But why does it feel like the effects of drinking are so much worse post-40? ‘The organs that metabolise alcohol such as the liver and the stomach shrink as you get older, so alcohol stays in your system longer,’ says Dr Tony Rao, consultant old age psychiatrist at the South london and Maudsley NHS Foundation Trust. This could explain that wretched two-day hangover post-40. ‘Plus, the total fluid in the body is a lot less - we get more dehydrated as we get older - so because alcohol is distributed in blood which will be more concentrated, it won’t be broken down as quickly as it would in the bloodstream of a 20 year old.’

Here’s what else alcohol is doing to your body post-40.

Brain

‘Alcohol gets through the blood-brain barrier where it works as a depressant,’ says Professor Wallace. ‘We feel quite excited and stimulated when we drink because it’s having a depressing effect on controlling behaviours such as judgement, self-monitoring, planning and reasoning’, he says. It explains why what seemed like great idea the night before is not so much the morning after. ‘Over time this gives you a higher propensity to mood problems such as anxiety and depression.’ In his NHS clinic specialising in alcohol problems, Dr Rao sees people in their 60s with subtle alcohol related brain damage after a lifetime of casual drinking. ‘I always say to my patients ‘Your brain is affected a lot earlier than your liver’’, he says. ‘Before we see the cirrhosis we see depression and problems with impulse control, moodiness, problems making complex decisions, say with finances and their children or spouses might say ‘Oh that’s just so-and-so being a silly old bugger,’ so the problems are missed.’ Good news is, the damage can be reversed after just six months of not drinking, he says.

Skin

Alcohol causes a flushing of the skin in those prone, says Professor Nick Lowe, consultant dermatologist and spokesperson for the British Skin Foundation. ‘This can trigger rosacea, a chronic redness in the skin because the blood vessels enlarge and produce more blood flow. Though the redness can go down, over time it can lead to a permanent enlargement of the blood vessels and visible thread veins on skin.’

These can be treated with pulsed light or vascular lasers but are better caught early for best results, he says. And those spots you get after a night out? Here’s why. ‘Alcohol can make people stressed and anxious and this stress produces the androgen hormones that stimulate acne,’ says Professor Lowe. And the reason heavy drinkers tend to look a little worse for wear? ‘The skin becomes dehydrated and and the fluid lost can lead to flakiness and puffiness around the eyes,’ he says. ‘Plus, the excess sugars you’re consuming - especially with beer and wine - damage the DNA and collagen in the skin which can lead to more rapid ageing.’

Heart

People who regularly binge drink - that’s classified as drinking double the daily limit of 3-4 units for a man and 2-3 for a woman or more in one session - dramatically increase their risk of stroke, says Professor Wallace. Drinking raises blood pressure both short and long term which increases heart attack and stroke risk. Excessive alcohol also damages the heart’s ability to pump, a condition called cardiomyopathy which increases risk of heart failure, says Dr Mike Knapton, associate medical director of the British Heart Foundation. But surely a glass of red wine a night is good for the heart? Knapton concedes that research does confirm this, ‘but the benefits come from less than one glass of red wine a day, so the first glass might do you good but anymore won’t.’

Liver

Liver disease has risen in the UK by a staggering 400 per cent since the 1970s. ‘Those at risk are not just chronic alcohol abusers, but also middle-aged, professionals who drink a little too much most nights,’ says Dr Debbie Shawcross, consultant hepatologist at King’s College Hospital Liver Unit. ‘The liver may start out a little fatty and then if you continue heavily drinking between say 40 and 55 the fat and inflammation creates scar tissue and the liver shrinks and - for about one in six people -can lead to cirrhosis or liver disease.’

The British Liver Trust suggests aiming to have three consecutive non-drinking days a week, to give it a chance to regenerate Anna Magee

The liver has a healthy ability to heal itself and the British Liver Trust suggests aiming to have three consecutive non-drinking days a week, to give it a chance to regenerate - they also have an iPhone app called Spruce that helps you work alcohol free days into your week.

Cancer risk

Each year about 13,000 cases of cancer in the UK are attributed to alcohol consumption. ‘In terms of cancer risk, there is no safe level of drinking,’ says Nicola Smith, health information officer for Cancer Research UK. ‘The cancers most closely linked to alcohol consumption are those of the mouth, oesophagus, bowel, breast and throat,’ she explains. The more you drink, the higher your risk because ethanol in alcohol is broken down into acetaldehyde which damages DNA and directly impacts cells that cause cancer. Plus, ‘If you’re smoking and drinking at the same time, you’re increasing your risk of mouth and throat cancer because alcohol makes cells more responsive to the toxins in tobacco smoke,’ she says. This effect is even in casual drinker/smokers, she asserts.

Fertility

A pioneering Danish study of thousands of couples who had discontinued contraception in order to conceive found that tee-totallers got pregnant much sooner than even very light 'social' drinkers and they had a lower miscarriage rate. Even where couples resort to IVF, a US study found that moderate drinking (half a bottle of wine a week) was associated with an 18 per cent reduction in success rates for women. ‘For men, excessive alcohol consumption lowers testosterone levels and reduces sperm quality and quantity,’ says Dr Gillian Lockwood, fertility specialist and medical director of Midland Fertility. The 'sperm cycle' is 70 days, so the damaging effect of a serious binge may take a couple of months to improve, a more serious consideration for men over 40 whose sperm is already declining in quality’.

Weight

Alcohol contains seven calories per gram, nearly the same as fat (9 calories per gram) and when you drink the body recognises its by-products as toxins and chooses to break these down first over the nutrients in food, explains nutritionist Robert Hobson, co-author of The Detox Kitchen Bible. ‘ When the body gets round to metabolising the food, it may no longer require the calories, so they get stored as fat.’

Studies also show that drinking can suppress the hormone leptin, which controls appetite which is why people can over eat when drinking. As a sugar source, alcohol raises insulin and turns on fat storage by increasing fatty deposits in the liver and , in middle age, excess can lead to fat storage around the stomach - a root cause of the classic ‘beer belly’.